The effectiveness of cervical cerclage in twin pregnancies with a mid-trimester short cervix: A retrospective cohort study

•Cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.•Cumulative published data show promising results in favor of cerclage in twins but mostly based on cohort studies.•Routine vaginal ultrasound mid-trimester cervical length scr...

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Bibliographic Details
Published in:	European journal of obstetrics & gynecology and reproductive biology Vol. 294; pp. 33 - 38
Main Authors:	Ferro, Jaime, Diago, Vicente, Diago, Diana M., Pellicer, Nuria, Olmo, Inés, Vázquez, Sheila, Lara, Coral, Perales, Alfredo, Serra, Vicente
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier B.V 01-03-2024
Subjects:	Cerclage Cervix Preterm birth Twin pregnancy PB Preterm birth SPB Cerclage CL Cervix Twin pregnancy
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Summary:	•Cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.•Cumulative published data show promising results in favor of cerclage in twins but mostly based on cohort studies.•Routine vaginal ultrasound mid-trimester cervical length screening is highly recommended. To analyze the effectiveness of cerclage in twin pregnancies with a short cervix. Retrospective cohort study performed in two University Institutions in Valencia (Spain) with two different protocols for the management of asymptomatic dichorionic diamniotic twin pregnancies with mid-trimester cervical length ≤ 25 mm: treatment with indomethacin, antibiotics and cerclage (cerclage group) (N = 43) versus expectant management (control group) (N = 37). The initial cervical length was similar in both groups but detection of a short cervix was performed earlier in the cerclage group (21.6 vs 24.1 weeks, p < 0.001). Women with cerclage had a greater pregnancy latency (12.5 vs. 7.7 weeks, p < 0.001); higher gestational age at delivery (34.1 vs. 31.8 weeks, p < 0.04); less spontaneous preterm birth (SPB) < 28 weeks (11.6 % vs 37.8 %, p < 0.009); higher birthweight (2145 vs 1733 g, p < 0.001); lower birthweight < 1500 g (12.5 % vs 40.0 %, p < 0.001); less admissions to the neonatal intensive care unit (NICU) (24.1 % vs 43.3 %, p < 0.03); shorter stay at NICU (25.6 vs 49.4 days, p < 0.02); lower respiratory distress requiring mechanical ventilation (14.9 % vs 36.5 %, p < 0.02); fewer patent ductus arteriosus (8.9 % vs 26.9 %, p < 0.008); and lower composite adverse neonatal outcome (26.6 % vs. 44.8 %, p < 0.03). Cerclage and gestational age at diagnosis were the only independent predictors of SPB < 32 and < 28 weeks by multivariate analysis. The cumulative data in the literature show promising beneficial effects of cerclage. Our data suggest that cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0301-2115 1872-7654
DOI:	10.1016/j.ejogrb.2023.12.029